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57 N 775 E Tremonton UT 84337-4103 | |
(435) 915-6262 | |
(435) 201-8200 |
Full Name | |
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Speciality | Family Medicine |
Location | 57 N 775 E, Tremonton, Utah |
Authorized Official Name and Position | Todd J Miller (OWNER) |
Authorized Official Contact | 4359156262 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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57 N 775 E Tremonton UT 84337-4103 Ph: (435) 915-6262 | 57 N 775 E Tremonton UT 84337-4103 Ph: (435) 915-6262 |
NPI Number | 1871240580 |
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Provider Enumeration Date | 03/03/2022 |
Last Update Date | 10/07/2024 |
Medicare PECOS PAC ID | 9931632528 |
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Medicare Enrollment ID | O20241105000574 |
Identifier | Type | State | Issuer |
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1871240580 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Todd James Miller |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1780877191 PECOS PAC ID: 0941390512 Enrollment ID: I20071219000636 |
Provider Name | Marci T Hidalgo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326680265 PECOS PAC ID: 1759700271 Enrollment ID: I20201002001520 |
Provider Name | Holly Matthews |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619721958 PECOS PAC ID: 9739613217 Enrollment ID: I20241106001246 |